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Reviews and Notices of Books.Cours de Therapeutique, professe à la Faculté de Médecine.

Par ADOLPHE GuBLER. Paris : Bailliere.

THE name of Professor Gubler is probably not much knownin this country, but few recent French physicians haveinspired more affectionate regard and esteem among theirpupils, or have at their death been more lamented. Hislast course of lectures was completed in July, 1878, and sincehis death they have been published under the supervision ofDr. Bordier. They have, however, been given to the publicunaltered, from the shorthand notes of one of his pupils.The volume fully maintains its author’s reputation. It isclear and fairly concise in style, and exhibits a wide

knowledge of facts, old and new. The lectures possess,however, a characteristic which is very common at the

present day in French medical literature-an endeavour, byextensive generalisation, to include all facts under generallaws in a firm, if courteous, dogmatism, which does not like,and often will not tolerate, differences of opinion.The work is not a systematic treatise on Therapeutics, but

rather a sketch of the general principles of the action anduse of remedies, illustrated by examples, some of which aregiven in considerable detail. Some general considerationson the nature and effects of remedies occupy the first fourlectures. The various modes by which they are introducedare described in the next seventeen lectures. Four arethen devoted to a consideration of the changes whichdrugs undergo in the system; and in the re-

maining lectures are discussed the modes of elimina-tion of drugs, and the question of their antagonism.Drugs constitute but a part of our therapeutic arsenal, andthe author’s first task is to draw the necessary distinctionbetween remedies and medicaments. He insists, with justice,on the therapeutical importance of many remedies which arenot usually noticed in a survey of the subject. Foremost

among these are moral agents, in which are included amuletsand homoeopathy-" encouragement and clear water" con-stituting the essential muniments of the latter. The me-chanical and chemical effects of drugs are next glanced at,and the author then discusses the modus operandi of thelarge class of agents which do not act in either of theseways. Many drugs and articles of diet are capable of pro-ducing a profound effect even when given in small quantity.The theory is advanced that their operation is by yieldingforce to the system. The argument is based on the analogyof the liberation of force (heat, light, &c.) by substances inchanging their state, and it is urged that no other theory isconceivable. It must be confessed, however, that the directevidence in support of this theory is very small. Of an

explanation of the action of many agents, as alcohol, coffee,&c., that they spare the tissues by lessening tissue consump-tion, Professor Gubler speaks in terms of contempt, but hebrings forward no destructive evidence. Much as there is in

physiology which cannot be explained by the known factsof mechanics and chemistry, there is even more that is thusinexplicable in pharmacology and therapeutics. The addi-tion to the " radical forces of the organism is regarded asthe essential action of tonics, and stimulants are distin-

guished as agents which merely excite the evolution of theforce furnished by the tissues. The ultimate effect is the

same, the path by which it is reached is essentially different.The one increases, the other lessens, the force-producingpower. The action of small and of large doses of strychniais given as an example of this difference. The idea is, of

course, that which underlies the name of " tonic " and

"stimulant," but it may be doubted whether modern

physiological knowledge should not make us hesitate beforeaccepting it. That a simple stimulant may act ultimately

as a tonic, the effect of muscular exercise, voluntary orthat artificial exercise which is produced by galvanism,abundantly shows; and it may well be that many truetonics are purely stimulant in their mode of action. Theelective action of drugs on different parts is explained partlyby their mode of elimination, and partly by analogues ofchemical constitution between the drug and the tissues. Theformer explanation does but push the mystery a little furtherback, while the latter, supported though it is by the opinionof Liebig, rests on so small a basis of even presumptiveevidence that it seems better to confess our ignorance thanto attempt a dogmatic explanation.In considering the medicinal substances which are drawn

from the vegetable kingdom, M. Gubler directs attention tothe remarkable illustration which they present (and whichmany inorganic drugs present likewise), that their influencehas no relation to the constituents, but depends on theproportion and mode of arrangement of their elements. Drugswhich are inert and those which are most potent are com.posed for the most part of the same elements. Their differ-ent action depends on the way these elements are grouped;as, for instance, we see in the similarity of combination inall the ansesthetics. Moreover, the most potent of the con.stituent elements-nitrogen-seems to render the compoundsless active. Atropine contains less nitrogen than morphia;morphia less than theine. A still more striking instance ofthe effect of combination is afforded by arsenic, which, sopotent a poison in an isolated form, is powerless when com-bined in cacodyl. Thus a slight change in constitution mayprofoundly alter the action of a drug. The beautiful dis.coveries of Fraser are quoted in illustration of this. Thesubstitution of a molecule of ethyl for one of hydrogen instrychnia converts the most powerful tetanising agentknown into one which paralyses the muscles, and thus weare able to understand how it is that the source of curaraand of strychnia is almost the same.The method by which medicaments are introduced into

the system constitutes the next topic. The necessity thereis that the substance should be in a liquid state is pro-vided for, to some extent, by the solvent powers of the

digestive juices, and of this one of the most important in-stances has only recently become known-the solvent powerof albumen, contained so abundantly in the mucus of the ali.mentary canal, and which can dissolve even metallic mercury.But this method of administration has its disadvantages in thegastric irritation which many drugs occasion, and in the in-terference which they cause with the digestive process. Aninstance of the latter is furnished by some experiments withphosphorus. Having noticed a disturbance of digestionwhen phosporus was given with food, M. Gubler obtainedsome gastric fluid from the dog by means of a biliaryfistula. He placed some in a series of tubes with pieces ofmeat, and to some of these he added powdered phosphide ofzinc. In a certain number of hours the tubes which con-tained only meat and gastric juice remained unaltered,while in those to which the phosphide of zinc had beenadded the meat was softened, browned, and half transpa-rent. He has suggested an ingenious method by which thegastric irritation may be avoided and drugs kept from con.tact with the mucous membrane until the intestine isreached. This consists in enveloping them in fatty matterwhich is not acted upon in the stomach, but which becomesiemoved and absorbed when it reaches the intestine. It hasbeen proposed to administer bile in this way when the se-cretion of the liver is deficient.

Into M. Gubler’s discussion of the advantages and dis-advantages of the introduction of remedies by the othermucous surfaces we cannot follow him in detail, but maymention one or two of the points on which he lays specialstress. The statements which have been made regarding

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the absorptive power of the mucous membranes of thebladder and vagina are singularly contradictory, but arereconciled by the different conditions under which the ob-serv-jtions have been made. In health the absorptive powerof these surfaces is very small ; in disease it is very active.Hence, under the conditions in which we most want thelocal effect of remedies, we may apply them without hesita-tion, if they are not deleterious to the general system. Ofall the mucous membranes the most active can be utilised

only for vapours-that of the lungs. Some instances men-tioned of the absorptive power of the lungs for liquidsdeserve to be better known. It was found at Alfort that fromten to fifteen litres of water introduced into the lungs of ahorse were absorbed with great rapidity. Indeed, a constantcurrent of water might be thrown into the air-passages, andthe animal might die from the effect of the water on theblood and tissues, and yet the lungs after death be foundfree from water. These and other facts furnish a rationalbasis for the introduction of atomised liquids by the lungs,and even, within restrictions, of atomised solids. These

subjects are discussed at length, and very ably, in the pagesof M. Gubler’s work.

An interesting chapter is devoted to the question of theadministration of drugs through the undamaged skin. The

experiments which have been made as to the absorptionthrough the skin are carefully examined in the light of theauthor’s own investigations. The facts that iodide of

potassium is not absorbed from a bath, while a solutionallowed to dry upon the skin is absorbed, are at first sightcontradictory. Their reconciliation is found in the law that

watery solutions are not absorbed, but that volatile sub-stances do enter the system through the skin, apparently bytheir power of diffusion into the glands. If iodide of

potassium is allowed to remain in contact with the skin, itis decomposed by the fatty acids, and the iodine thus passesin. Moreover, fatty substances are readily absorbed by thesebaceous follicles, and may carry with them substanceswhich are dissolved in them, or which are in a state of finesuspension. The secretion of the sebaceous follicles, whichfacilitates this, hinders the absorption of watery solutionsjust as an oiled filter allows fat to pass through, and doesnot allow the passage of a watery solution which may bemixed with the fat. Thus many liniments, the basis ofwhi’;h is oily, are effectual. Moreover, the absorption isfavoured by substances, such as chloroform, which can dis-solve fatty matters, and therefore the secretion of the seba- ’ceous follicles. The absorption of volatile, non-fatty sub-stances is most active where the sebaceous glands are fewest,as in the axilla and groin.The hypodermic method of administration receives its full

share of attention, no less than five lectures being devotedto history, methods, application, theory, and dangers. The

facts, admirably described, are for the most part well known.The author’s opinion on the much-discussed question of therelative value of local injections-i.e., made into the partwhich is the seat of the disease-is worthy of note. His

experience of the use of the hypodermic method is so

large that his opinion on this point deserves special weight.It is strongly in favour of injection into the seat of thedisease. The facts adduced in support of this view are,if well observed, conclusive. He states that in patientssuffering from the rare condition of double sciatica the painin the leg into which the injection is made is relieved farmore than that in the other, and that this observation may bemade alternately on either leg. Another interesting obser-vation relates to the diminution of sensibility often to benoticed around the seat of the injection. He has observedthis with injections of various substances, and uniformlywhen water only was injected. He attributes it to thehydration of the cutaneous nerves in their subcutaneous

course. It passes off when the local excess of water isremoved. To this action the effect of injections of purewater is to be ascribed. He relates the case of a patient inwhom he frequently substituted an injection of water forone of morphia, always with the effect of temporarilyrelieving the pain, which returned, however, much soonerwhen water was injected than when morphia was used.The next four lectures are devoted to a consideration of

the modifications which drugs undergo in the organism,illustrated by a lengthy and detailed study of the action ofarsenic, in which, however, there is little that calls for

special notice. Of more interest is the subject of the elimi-nation of medicines, which is next examined at length. The

faculty of generalisation, here as elsewhere throughout thework, carries the author into positions which are, we willnot say untenable, but certainly less impregnable than theirmode of statement would imply. For instance, he finds anexplanation of a large class of facts in regard to the actionand elimination of drugs in the relation which they bear tothe constituent elements of the tissues. " Drugs are rejectedthe more rapidly, the more widely they differ from the normalcomponents of the organism." Bernard has shown that thesalts of potash are not tolerated so well as those of soda ;they are indeed " muscular poisons." This is because thereis little potash normally in the blood. Hence the potash isnot expelled from the blood. The muscles contain normallymuch potash, and hence the potash in the blood accumulatesin them in an excess which interferes with their nutrition.In the case of other salts the action of the same law is seen.Chlorides are better tolerated than bromides, and thesethan iodides, " always for the same reason " that thechlorides are in abundance in the organism, and henceare eliminated more rapidly. " Tolerance or intolerancefor a substance is explained by its homogeneity or hetero-geneity with regard to the organism which receives it."The reader will probably hesitate to accept the "law" as thesole explanation of the facts, and his hesitation will not belessened when he reads, two pages further on, of some factswhich are scarcely reconcilable with it (although the authorappears unconscious of this)-namely, that iodide, bromide,and chlorate of sodium are eliminated twice as slowly asthe corresponding salts of potash, and that the same is trueof the carbonates of soda and potash respectively. In truth,our knowledge of the action of drugs and the physiologicalchemistry of the tissues will probably have to be muchmore extensive before we can formulate the laws on whichtheir elimination depends. We have not space to followthe author in his discussion of other facts relating to theelimination of drugs, and to their accumulation in thesystem.

’, In the final lectures the subject of the antagonism ofmedicines is very ably discussed, but on this subject wemust refer the reader to the work itself. It will well repayperusal. As a guide to students, the small field which itcovers, and the large amount of hypothesis which it con-tains, render it scarcely suitable. The teacher of thera-

peutics, however, will be rewarded by its study, on ac-

count of the extensive knowledge of facts, many of whichare unfamiliar, the quickness to seize the relations of thosewhich are apparently distant, and the long experience,which it displays.

Headache their Nature, Causes, and Treatment. ByWILLIAM HENRY DAY, M.D., M.R.C.P. Lond., &c.Third Edition. J. & A. Ctmrchill.

WHEN a work reaches a third edition, it may claim tohave justified its author in writing it, and to be pretty in-dependent of reviewers. There have been many previousworks on headache, but it is to be admitted that Dr. Daywrites at some advantage over his predecessors, inasmuch

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as he is in possession of a deeper physiological knowledgeof the problems involved in headache than was possiblebefore the researches of Bernard, Ferrier, Jackson, andothers. We are not yet, however, in possession of any suchphysiological knowledge as will enable us to comprehend allthe mysteries of headache, or to know why one person’shead is so constituted that it is more easy to say when it isnot aching than when it is, and another’s is so constructedthat it never aches at all; why one person’s headachealways occurs on a Monday, and another’s on a Friday,both of which are within our clinical experience. We e arenot yet ripe for any strict pathological theories of head-aches. Dr. Day wisely says that " he has relied rather onthe investigations of facts as presented by the record of cases,than trusted to plccacsible theories."In successive editions we should advise Dr. Day to discard

theories even more freely than he has done, and all butstrictly clinical classifications of his subject. By so doinghe will still further simplify it. Some of his chapters seemtautological; as, for example, when he devotes one chapterto headache of cerebral hypermmia, another to congestiveheadache, and another to plethora and increased vascularaction. He describes no less than thirteen kinds of head-

ache, exclusive of a chapter on headaches of childhood andearly life, in which he mentions seven kinds of headache.It is, of course, difficult to discuss headache by itself, andto attempt to do so requires some justification. But it is so

conspicuous and " commanding " a feature of human suffer-ing that physicians may well be excused for giving it specialconsideration, though no better illustration could be adducedof the impotence of " specialism " than when it attempts toseparate and to treat headache as an isolated disease. Dr.

Day takes no such limited view of his subject, but, as apractical physician, regards it in the light of his patient’sage, circumstances, history, and diathesis; he brings tobear upon it a large amount of experience and medicalknowledge, and makes many therapeutical suggestions ofmuch value.

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On Preser1Jation of Health in India. A Lecture, addressedto the Royal Indian Engineering College at Cooper’s-hill,May 17th, 1880. By Sir JOSEPH FAYRER, K.C.S.I., &c.

THE object of this lecture was to give to the young meneducated at Cooper’s-hill such information about the climate,mode of living, diseases, and means of preserving health inIndia, as would be likely to prove useful to them in thepeculiar circumstances under which they are placed on com-mencing their service in that country. It appears that therehas been a great amount of sickness among the youngengineers who have gone out to India, and that much of itwas of a preventable character, and might have been avoidedby a very moderate amount of information as to the mode oflife to be followed on first arrival in the country, and thebest course to be taken to meet the first symptoms of illness.To remedy as far as possible the effects of this want of

knowledge, Sir Joseph Fayrer was requested to deliver thislecture. In it he has given a brief sketch of the climateof the various parts of India in which the engineers areemployed, and has pointed out the more prominent causes ofdisease and the best means of counteracting them. Thelatter may be briefly summarised as-Lead regular lives,avoid excesses of all kinds, take regular exercise, keep thebowels open, wear flannel, and as far as possible avoid ex.posure to the sun. He has also given a short description ofthe most prevalent diseases, and the measures to be adopteduntil medical aid can be obtained; and an interesting accountof the effects of snake-bites, and how to treat them-a

subject upon which he may be justly considered the highestauthority. The lecture cannot fail to prove useful to thoseto whom it was addressed; but we would suggest to Six

Joseph Fayrer that he would confer a still greater benefitupon them if he made it the groundwork of a short hand-book on the subject, prepared with special reference to thework upon which, and the circumstances under which, theCivil Engineers in India are employed.

New Inventions.EXPLORING ASPIRATOR.

MESSRS. ARNOLD have made for Dr. Hensley of St. Bar.tholomew’s Hospital an exploring aspirator. It consists

essentially of a syringe in combination with a cannula andtrocar; the cylinder of the syringe being prolonged into afine cannula, while the piston-rod is continuous with the

trocar, so that the retraction of the trocar and of the pistoncausing aspiration is by one movement. The cylinder of thesyringe is a glass tube fitted with similar screws at bothends, one of which fastens into the collar of the piston-rod;the other (3 in the figure) takes a screw-cap, by means ofwhich cannulae of different sizes may be fixed in air-tight

connexion. The needle passes completely through the piston-rod, and, when the syringe is filled, may be withdrawn byunscrewing at 2; the elastic tube, 1, can then be easily at-tached without any risk of air passing through the cannula.The advantages of this instrument, as compared with the

ordinary subcutaneous syringe used for diagnosis, are:

it is stronger and made with a larger tube ; the needle-

point is at once withdrawn, and the orifice of the instrumentcannot get blocked in inserting it; whilst after being usedfor exhaustion, it may be employed for the injection of anti-septic or other fluids if required. As compared with a largeraspirator, the advantages it possesses appear to be, that therisk of admitting air is considerably diminished, whilst theglass cylinder affords means of observing the flow of fluidclose to its point of exit ; also that a smaller cannula maybe used than can be employed with a larger instrument.It is important, in using it, to see that all the fittings are inworking order, and screwed tight.

DR. HAMERTON, resident medical officer of theLambeth Infirmary, was presented with a handsome testi-monial, on the occasion of his leaving, by the officers andothers connected with the institution; it consisted of a micro-scope by Baker, a pocket case of instruments, a gold pencil-case, and a diamond breast-pin. Great regret was expressedby all at his leaving, he having held the oiiice more than fiveyears, and during all that time he was universally respectedby his fe]Llow-officers and loved by his patients.BUTTERINE.- In a Dublin police-court last week,

five traders were fined jE2 each for exposing for sale as

genuine butter a substance known as "butterine," or oleo-margarine. This is the first occasion in Dublin that a prose-cution has been instituted for the sale of butterine.